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Toxic Shock Syndrome (TSS)

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a cluster of symptoms that involve many systems of the body. Certain bacterial infections release toxins into the blood stream. These then spread the toxins to many body organs. This can cause severe damage and illness.

What causes toxic shock syndrome?

The following bacteria commonly cause TSS:

Staphylococcus aureus

Streptococcus pyogenes

Clostridium sordellii

TSS from Staphylococcus infections was identified in the late 1970s and early 1980s when highly absorbent tampons were widely used by menstruating women. Due to changes in how tampons are made, the incidence of tampon-induced TSS has declined.

TSS from Streptococcus infections is most commonly seen in children and the elderly. Other people at risk include those with diabetes, weak immune system, chronic lung disease, or heart disease.

Staphylococcus infections. Staphylococcus aureus (or S. aureus) may normally exist on the surface of a person's body and does not cause infection. Because it's part of the body's normal bacteria, most people develop antibodies to prevent infection. S. aureus can be spread by direct contact with infected people. People who develop TSS usually have not developed antibodies against S. aureus. Therefore, it's not usually considered a contagious infection. S. aureus infections may also develop on top of another infection. These include pneumonia, sinusitis, or skin wounds, such as a burn or surgical site. If S. aureus develops in any of these areas, the toxin produced by the bacteria can penetrate into the bloodstream.

Streptococcus infections. Streptococcus pyogenes (or S. pyogenes) TSS may happen as a secondary infection. Most commonly, this is seen in people who have recently had chickenpox, bacterial cellulitis (infection of the skin and underlying tissue), or have weak immune systems.

Clostridium sordellii infections. Clostridium sordellii (or C. sordellii) normally exists in the vagina and does not cause infection. The bacteria may enter the uterus during normal menstruation, childbirth, or gynecological procedures, such as abortion. Intravenous drug use can also cause C. sordellii infections.

Who is at risk for toxic shock syndrome?

The following are risk factors for toxic syndrome:

History of using super-absorbent tampons

Surgical wounds

A local infection in the skin or deep tissue

History of using the diaphragm or contraceptive sponge

History of recent childbirth, miscarriage, or abortion

What are the symptoms of toxic shock syndrome?

Symptoms of TSS involve many systems and may look like other infections. While each person may experience symptoms differently, the following are the most common symptoms of Staphylococcal TSS:

Fever higher than 102°F (38.9°C)

Chills

Feeling unwell

Headache

Fatigue

Rash that is red and flat and that covers most of the areas of the body

Shedding of the skin in large sheets, especially over the palms and soles, which is seen 1 to 2 weeks after the onset of symptoms.

Low blood pressure

Vomiting

Diarrhea

Muscle pain

Increased blood flow to the mouth, eyes, and vagina, making them appear red

Decreased urine output and sediment in urine

Decreased liver function

Bruising due to low blood platelet count

Disorientation and confusion

The following are the most common symptoms of Streptococcal TSS:

Dangerously low blood pressure

Shock

Decreased kidney function

Bleeding problems

Bruising due to low blood platelet count

Rash that is red and flat and that covers most of the areas of the body

Liver impairment

Shedding of the skin in large sheets, especially over the palms and soles (this does not always happen)

Difficulty breathing

The following are the most common symptoms of C. sordellii TSS:

Nausea and/or vomiting

Lethargy

Flu-like symptoms

Abdominal tenderness

Generalized swelling from fluid buildup

High white blood cell and red blood cell count

No fever

Low blood pressure

Very fast heart rate

How is toxic shock syndrome diagnosed?

Ruling out similar illnesses (such as Rocky Mountain spotted fever, among others) is critical in diagnosing TSS. Other diagnostic tests may include:

Lumbar puncture. A procedure involving the insertion of a needle in between the vertebrae of the spine to draw spinal fluid and check for bacteria.

How is toxic shock syndrome treated?

Your healthcare provider will figure out the best treatment for you based on:

How old you are

Your overall health and past health

How sick you are

How well you can handle specific medicines, procedures, or therapies

How long the condition is expected to last

Your opinion or preference

Treatment for TSS may include:

Giving intravenous (through a vein) antibiotics

Giving intravenous fluid to treat shock and prevent organ damage

Heart medicines in people with very low blood pressure

Dialysis may be needed in people who develop kidney failure

Giving blood products

Supplemental oxygen or mechanical ventilation to assist with breathing

Deep surgical cleaning of an infected wound

What are the complications of toxic shock syndrome?

TSS can result in amputations of fingers, toes, or limbs, or even death.

Can toxic shock syndrome be prevented?

Since reinfection is common, menstruating girls and women should avoid using tampons if they have had TSS.

Prompt and thorough wound care is crucial in avoiding TSS.

Minimal usage of vaginal foreign body items, such as diaphragms, tampons, and sponges can also help prevent TSS.

When should I call my healthcare provider?

TSS may start like other infections, but it can quickly progress to a seriously life-threatening disease. If a mild illness quickly becomes severe with whole-body symptoms, seek immediate medical attention.

Key points about toxic shock syndrome

Toxic shock syndrome describes a cluster of symptoms that involve many systems of the body.

It can be caused by Staphylococcus aureus, Streptococcus pyogenes, or Clostridium sordellii.

Early symptoms are similar to other infections but can progress quickly to become life-threatening.

TSS can be life-threatening and requires immediate medical attention.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that visit.